Growing up in Crown Heights Brooklyn in the 1950's and '60's had its advantages. In an overwhelmingly African-American neighborhood, as an adolescent, I was largely insulated from the virulent racism that characterized much of New York City during that period. This was a time that restricted covenants against blacks buying or renting in certain neighborhoods were routine (Starrett City being only one example), and to cross boundaries to certain neighborhoods could lead to beatings and worse. It was a time when police violence against blacks on the street and in custody was so routine that the courts virtually never acted to prosecute police attacks, one of the reasons many in the black community to this day react so strongly to white on black police shootings.
But Dean Street where my family lived seemed pretty much exempt from all of that; a block of carefully tended brownstone buildings, where we spent most days after school and on the weekends playing stick ball and Chinese hand ball (virtually no homework) under the watchful eye of "pillow ladies" who would threaten to tell your mother if they saw you doing something they didn't like. This feeling of being exempt from a racist New York all began to unravel for me at 11, when my babysitter died. Generally, 11 year-olds aren't given details about how someone dies, particularly if it's someone you know who is only 16. But in this case, a kind of collective outrage on our block made it so that even the kids knew.
My babysitter died because she was black, young, pregnant, and had a botched abortion. But the real reason she died was that after being admitted to St. John's Episcopal Hospital (now Interfaith) to deal with bleeding from the abortion attempt, she was inadvertently left in a hospital hallway and bled to death because the all-white staff didn't seem to remember she existed. I'm angry to this day because of the waste and bigotry that so permeated the city in those days, but I'm also angry because now, 50 years later, racial disparities in health care, even when adjusted for income, are still very much alive in America and New York State.
The Community Service Society just released a report based on data provided to us by the New York State Department of Health, "Promoting Equity & Quality in New York's Public Health Insurance Programs." It found that Black enrollees in public health insurance had significantly worse health outcomes than all other racial and ethnic groups in 10 out of 12 quality measures, including asthma, mammography, dental visits, and diabetes. All of the these measures are worse despite the fact that our state is paying billions of dollars to health plans -- New York State spends more on health care than any other state -- and not getting what public tax dollars are suppose to yield -- at least equity in health care provision, no matter what your color.
This seems the moment for the state and nation to stop this form of racism. We're on the eve of the greatest health care reform in a generation. At this pivotal moment, it would seem exactly the right time to expand coverage, make it affordable to everyone, improve quality, and put a final stake in the heart of the gross inequality that we've let persist in how health care is delivered to people of color.
The landscape has changed since the '50's. We have a black president and governor, we have a generation of young people looking for a color blind America, but we can't expect good will alone to change the racial problems in health care. We have to penalize health plans, hospitals, and doctors who don't do the right thing, and we have to reward those who start to do better. We also have to change the culture of health care, which doesn't put a premium on primary care but rather on exotic treatments and procedures for a wealthy elite. We can start by putting resources behind care that will save the most working Americans and limit government and foundation grants and tax exemptions that serve only a few. It may sound too democratic for some, but perhaps it's the moment to suggest it for health care and fulfill another part of the American dream.
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